November 20, 2019 was the eighth Mid-Year NYSAIS Health Care Consortium meeting. Member Schools and Austin & Co. meet twice per year to review plan utilization, wellness, and HR & benefits compliance. The Consortium was originally formed in 2011 by a group of NYSAIS schools to collectively buy health care, bend the cost curve, and maintain high quality benefits.
In attendance this year was also Empire BlueCross BlueShield, the insurance carrier for The Consortium. We kicked off the meeting with an insightful introduction from Empire’s President and CEO, Alan Murray, about health care in the US.
Murray is originally from Scotland and having lived with a publicly funded healthcare system, he believes universal healthcare is not the answer for the United States (US). Healthcare was one of the reasons why he moved to the US. His goal for Empire is to “make New York healthier”, he also went on to say that, “we can’t influence healthcare if people can’t afford it.”
The data is clear, we need to do a better job at eliminating the disparity that exists between communities. In NY for example, Murray referred to the difference between Manhattan and The Bronx, which has a much higher rate of chronic conditions.
The treatment for chronic conditions, such as heart disease, cancer, diabetes, and Alzheimer’s disease, are at high costs. They represent 90% of the nation’s $3.5 trillion in annual health care expenditures according to the Centers for Disease Control and Prevention (CDC).
Empire is doing their part to help us get healthy by spearheading initiatives such as:
- Keeping hospitals in network to reduce costs,
- Legislative action to limit costs hospitals can charge for out-of-network services,
- Rewarding physicians for evaluating healthcare, and
- Creating programs to evaluate the need for specialty drugs, educate doctors and members on getting routine services in office rather in the outpatient setting.
How can you prevent chronic conditions?
The CDC recommends making healthy choices, such as: not smoking, eating healthy, regular physical activity, avoid drinking too much, etc. Educating yourself and making healthier choices are the first steps to take as an individual.
As an employer, wellness program goals should be more than ROI or a retention and attraction tool. They are a great way to encourage healthier lifestyles with education, activities, rewards, tools, and resources.
As Murry shared, there are impactful ways employers and insurers can change behavior and contain unnecessary costs. With controlled barriers a health plan redirects members from utilizing a high cost service to lower costing alternative. For example, requiring Colonoscopy services to be received as an in office visit rather than an outpatient hospital procedure.
This concept can also be applied to prescription drugs thorough what’s called step therapy. This is where patients are required to try one or more generic or lower cost medication before a high cost medication is covered by insurance.
Only by working together – individual, employer, insurer, and providers – can we get healthier, contain costs, and make health care more affordable. For more guidance about how you can implement some of these practices in your employer health plan, please contact us.
About the NYSAIS Health Care Consortium
Since 2011, member schools of the New York State Association of Independent School (NYSAIS) have been collectively buying employee benefits, HR consulting, and benefits administration technology through the NYSAIS Health Care and HR Consulting Consortium (Consortium). Additional information about the Consortium is available at www.austin-co.com/our_education_clients/NYSAIS-Consortium_69_pg.htm or email firstname.lastname@example.org.